Provider Demographics
NPI:1588035430
Name:BERRO, FATMEH
Entity Type:Individual
Prefix:
First Name:FATMEH
Middle Name:
Last Name:BERRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REPUBLIC DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-3658
Mailing Address - Country:US
Mailing Address - Phone:313-522-5777
Mailing Address - Fax:313-436-5188
Practice Address - Street 1:1000 REPUBLIC DR
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3658
Practice Address - Country:US
Practice Address - Phone:313-522-5777
Practice Address - Fax:313-436-5188
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7101000624OtherSLP